Body mass and weight thresholds for increased prosthetic joint infection rates after primary total joint arthroplasty.

Abstract

BACKGROUND AND PURPOSE:

Obesity increases the risk of deep infection after total joint arthroplasty (TJA). Our objective was to determine whether there may be body mass index (BMI) and weight thresholds indicating a higher prosthetic joint infection rate.

PATIENTS AND METHODS:

We included all 9,061 primary hip and knee arthroplasties (mean age 70 years, 61% women) performed between March 1996 and December 2013 where the patient had received intravenous cefuroxime (1.5 g) perioperatively. The main exposures of interest were BMI (5 categories: < 24.9, 25-29.9, 30-34.9, 35-39.9, and ≥ 40) and weight (5 categories: < 60, 60-79, 80-99, 100-119, and ≥ 120 kg). Numbers of TJAs according to BMI categories (lowest to highest) were as follows: 2,956, 3,350, 1,908, 633, and 214, respectively. The main outcome was prosthetic joint infection. The mean follow-up time was 6.5 years (0.5-18 years).

RESULTS:

111 prosthetic joint infections were observed: 68 postoperative, 16 hematogenous, and 27 of undetermined cause. Incidence rates were similar in the first 3 BMI categories (< 35), but they were twice as high with BMI 35-39.9 (adjusted HR = 2.1, 95% CI: 1.1-4.3) and 4 times higher with BMI ≥ 40 (adjusted HR = 4.2, 95% CI: 1.8-9.7). Weight ≥ 100 kg was identified as threshold for a significant increase in infection from the early postoperative period onward (adjusted HR = 2.1, 95% CI: 1.3-3.6).

INTERPRETATION:

BMI ≥ 35 or weight ≥ 100 kg may serve as a cutoff for higher perioperative dosage of antibiotics.

• Authors: Anne Lübbeke, Matthieu Zingg, Diemlan Vu, Hermes H Miozzari, Panayiotis Christofilopoulos, Ilker Uçkay, Stephan Harbarth, Pierre Hoffmeyer
• Journal: Acta orthopaedica (Acta Orthop) Vol. 87 Issue 2 Pg. 132-8 ( 2016) ISSN: 1745-3682 [Electronic] Sweden
• PMID: 26731633 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Cefuroxime

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Antibiotic Prophylaxis
• Arthroplasty, Replacement, Hip (adverse effects)
• Arthroplasty, Replacement, Knee (adverse effects)
• Body Mass Index
• Body Weight (physiology)
• Cefuroxime (therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Middle Aged
• Prospective Studies
• Prosthesis-Related Infections (epidemiology, etiology)
• Risk Factors
• Treatment Outcome
• Young Adult